What Stands in the Way of Technology-Mediated Patient Safety Improvements? A Study of Facilitators and Barriers to Physicians’ Use of Electronic Health Records

Abstract

Objectives For electronic health records (EHR) systems to have a positive impact on patient safety, clinicians must be able to use these systems effectively after they are made available. This study's objective is to identify and describe facilitators and barriers to physicians' use of EHR systems. Methods Twenty research interviews were conducted with attending physicians who were using EHR at one of two Midwest community hospitals and/or at their respective outpatient clinics. Results Analyses yielded over 200 perceived facilitators and barriers, comprising 19 distinct categories. Categories of facilitators/barriers related to user attributes included learning, typing proficiency, understanding the EHR system, motivation/initiative, and strategies/workarounds. Categories related to system attributes were supporting hardware/software and system speed, functionality, and usability. Categories related to support from others were formal technical support, formal training, and informal support from colleagues. Categories of organizational facilitators/barriers were time allowance and inter-institutional integration. Categories of environmental facilitators/barriers were physical space, electricity, wireless connectivity, and the social environment. Conclusion Together, the broad set of discovered facilitators and barriers confirms and expands prior research on the facilitators and barriers to health information technology use. The depth of reported information on each facilitator and barrier made possible by qualitative interview methods contributes to the theoretical understanding of facilitators and barriers to EHR use. Equally as important, this study provides an information base from which relevant policy and design interventions can be launched in order to improve the use of EHR systems and, thus, patient safety.

Perceived critical success factors of electronic health record system implementation in a dental clinic context: An organisational management perspective

“…These findings resonate with the analysis of similar studies of healthcare professionals' (physicians and nurses) perceived facilitators and barriers to the use of EHR, where the incongruence between expectations, functional attributes and organisational support produce an environment that is not supportive of effective health information technology (e.g. [61,62].…”

The patient work system: An analysis of self-care performance barriers among elderly heart failure patients and their informal caregivers

“…Many prior studies have applied work systems models to understand barriers to clinician performance (e.g., Carayon et al, 2014; Gurses & Carayon, 2007; Gurses et al, 2012; Holden, 2011; Pennathur et al, 2013; Wiegmann et al, 2010). However, ours applies a work system model or PWS to study person, task, tool, and context related barriers to the work performance of patients and informal caregivers .…”

Classification of antecedents towards safety use of health information technology: A systematic review

“…SEIPS model can be used to analyse or categorise the contributing factors of patient safety events, and anticipate potential safety consequences of the introduction of health IT [29]. The model has been used in many studies [30][31][32] with regards to impact of health IT on patient safety. A study to evaluate the impact of BCMA at two large paediatric hospitals in US was build according to the SEIPS model [30].…”

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